Sport injuries in international masters rowers: a cross-sectional study

Examining the Peer-Reviewed Published Literature Regarding Low Back Pain in Rowing: A Scoping Review

Background

Low back pain (LBP) is highly prevalent in the rowing population. The body of existing research variously investigates risk factors, prevention, and treatment methods.

Purpose

The purpose of this scoping review was to explore the breadth and depth of the LBP literature in rowing and to identify areas for future research.

Study Design

Scoping review.

Methods

PubMed, Ebsco and ScienceDirect were searched from inception to November 1, 2020. Only published, peer-reviewed, primary, and secondary data pertaining to LBP in rowing were included for this study. Arksey and O'Malley's framework for guided data synthesis was used. Reporting quality of a subsection of the data was assessed using the STROBE tool.

Results

Following the removal of duplicates and abstract screening, a set of 78 studies were included and divided into the following categories: epidemiology, biomechanics, biopsychosocial, and miscellaneous. The incidence and prevalence of LBP in rowers were well mapped. The biomechanical literature covered a wide range of investigations with limited cohesion. Significant risk factors for LBP in rowers included back pain history and prolonged ergometer use.

Conclusion

A lack of consistent definitions within the studies caused fragmentation of the literature. There was good evidence for prolonged ergometer use and history of LBP to constitute risk factors and this may assist future LBP preventative action. Methodological issues such as small sample size and barriers to injury reporting increased heterogeneity and decreased data quality. Further exploration is required to determine the mechanism of LBP in rowers through research with larger samples.

Lumbar discectomies in elite rowers: presentation, operative treatment, and return to play

OBJECTIVE

In a cohort of elite rowers requiring lumbar spine surgery, we report information regarding: (1) presentation, (2) operative treatment, and (3) return to play (RTP).

METHODS

All competitive rowers undergoing spine surgery at a single academic institution from 2015 to 2020 were analyzed. Three rowers underwent spine surgery during the allotted time period. Demographic, clinical, operative, and RTP data was recorded. Each athlete's self-reported level of effort/performance was assessed before and after surgery. First RTP was defined as the time of initial return to rowing activities, and full RTP was defined as the time of unrestricted return to rowing activities. Descriptive statistics were performed.

RESULTS

The three collegiate rowers ranged from 20- to 21-year-old, each with L5/S1 disc herniations. Preoperative pain levels ranged from 8 to 10, and inciting injury events included back squats, front squats, and rowing during the 'finish' stage. Each athlete underwent a minimally invasive, unilateral L5/S1 decompression, partial medial facetectomy, and partial discectomy with microscopic-assistance. First RTP ranged from 4-6 months, with full RTP at 6-8 months. Pain dissipated to the 0-1 range at full RTP. Final effort/performance improved from 10-60% mid-injury to 90-100% at full RTP. Each athlete's 2000m row time showed a decline mid-injury and an improvement to at or within 10 s of their pre-injury time.

CONCLUSIONS

Drawing from three collegiate rowers who underwent lumbar decompression surgery, each athlete successfully returned to rowing, with initial RTP in the 4-6 months range and full RTP in the 6-8 months range. Performance levels rebounded to near or better than pre-injury performance. The results of this small case series warrant replication in larger, multi-institutional samples.

Patterns of Intervertebral Disk Alteration in Asymptomatic Elite Rowers: A T2* MRI Mapping Study

Background:

Repetitive loading of the back puts elite rowers at risk for acute and chronic back injuries.

Hypothesis:

That asymptomatic elite rowers would demonstrate characteristic intervertebral disk (IVD) alterations on T2* magnetic resonance imaging (MRI) mapping compared with asymptomatic nonrowers.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

This study included 20 asymptomatic elite rowers (mean age, 23.4 ± 3.03 years; 9 women, 11 men) studied at 2 different times, once before (t₁) and once after (t₂) the competition phase. MRI including T2* mapping was performed on a 3-T scanner. The authors derived normative T2* data from a previous study on 40 asymptomatic volunteers (20 men, 20 women) who were not competitive rowers; based on complete T2* data sets, 37 controls were included. T2* values were compared between groups in 4 lumbar IVDs, and midsagittal T2* values were compared in 5 zones: anterior annulus fibrosus (AF), anterior nucleus pulposus (NP), central NP, posterior NP, and posterior AF. The Pfirrmann grade was used for morphological assessment of disk degeneration. Statistical analysis was conducted using the Mann-Whitney U test, Wilcoxon matched-pairs test, and Spearman rank correlation coefficient.

Results:

Lower T2* values were noted in the rower group compared with the controls (37.08 ± 33.63 vs 45.59 ± 35.73 ms, respectively; P < .001). The intersegmental comparison revealed lower mean T2* values among rowers (P ≤ .027 for all). The interzonal comparison indicated significantly lower mean T2* values for the rowers in all zones except for the anterior NP (P ≤ .008 for all). Lower mean T2* values were observed for the rowers at t₁ versus t₂ (39.25 ± 36.19 vs 43.97 ± 38.67 ms, respectively; P = .008). The authors noted a higher level of IVD damage according to Pfirrmann assessment in the rower cohort (P < .001); the Pfirrmann grade distributions of rowers versus controls, respectively, were as follows: 51.3% versus 73.7% (grade 1), 20.5% versus 19.5% (grade 2), 21.8% versus 6.8% (grade 3), 5.1% versus 0% (grade 4), and 1.3% versus 0% (grade 5). The authors also noted a correlation between low T2* and high Pfirrmann grade at t₁ (r =–0.48; P < .001) and t₂ (r =–0.71; P < .001).

Conclusion:

The cohort of elite rowers revealed more degenerative IVD changes compared with controls. The T2* values suggest that repetitive loading of the spine has demonstrable short-term and possibly permanent effects on the lumbar IVD.

Common health issues and advised treatments reported in an ultraendurance ocean rowing race

Objectives

Ocean rowing is an extreme ultraendurance sport where individuals row unsupported across an ocean. This can mean months at sea in unpredictable and inhospitable conditions. The extreme physical and mental demands associated mean medical issues are common yet under researched, impacting the medical assistance provided.

Methods

The Talisker Whisky Atlantic Challenge provides a framework with safety protocols to create safer environments for athletes to attempt transatlantic crossings. Race logs, which record communication between rowers and safety teams, were anonymised and examined to create cumulative totals of medical issues requiring help and an incident timeline.

Results

Duty officers were notified of 65 medical complaints, 32% (n=21) requiring race doctors. Dermatological conditions were most common, accounting for 32% of complaints (n=21) and affecting 24% of rowers. Pressure sores and infections represented 43% and 38% of dermatological complaints respectively. Musculoskeletal injuries equalled 18% (n=12) of complaints, affecting 20% of rowers. Most cases were reported in weeks one and three, with 37% (n=24) of issues and 90% (n=10) of seasickness cases in week one. Hygiene and antibiotics were frequently advised management options.

Conclusion

Conditions requiring race doctor input represent the most severe cases with the potential to deteriorate. Managing dermatological and musculoskeletal issues is vital throughout the race, while seasickness prophylaxis and education is essential in initial race stages. Infections are cause for concern, with gluteal pressure sores a potential route for secondary infections. Further research is required before evidence-based guidelines for management of health issues in ocean rowers can be introduced.

Prevalence and risk factors for back pain in sports: a systematic review with meta-analysis

OBJECTIVES

We aimed to determine the prevalence of low back pain (LBP) in sport, and what risk factors were associated with LBP in athletes.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

Literature searches from database inception to June 2019 in Medline, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus, supplemented by grey literature searching.

ELIGIBILITY CRITERIA

Studies evaluating prevalence of LBP in adult athletes across all sports.

RESULTS

Eighty-six studies were included (30 732, range 20-5958, participants), of which 45 were of 'high' quality. Definitions of LBP varied widely, and in 17 studies, no definition was provided. High-quality studies were pooled and the mean point prevalence across six studies was 42%; range 18%-80% (95% CI 27% to 58%, I2=97%). Lifetime prevalence across 13 studies was 63%; range 36%-88% (95% CI 51% to 74%, I2=99%). Twelve-month LBP prevalence from 22 studies was 51%; range 12%-94% (95% CI 41% to 61%, I2=98%). Comparison across sports was limited by participant numbers, study quality and methodologies, and varying LBP definitions. Risk factors for LBP included history of a previous episode with a pooled OR of 3.5; range 1.6-4.0 (95% CI 1.9 to 6.4). Statistically significant associations were reported for high training volume, periods of load increase and years of exposure to the sport.

CONCLUSION

LBP in sport is common but estimates vary. Current evidence is insufficient to identify which sports are at highest risk. A previous episode of LBP, high training volume, periods of load increase and years of exposure are common risk factors.